BACKGROUND:The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of ...the many factors significantly associated with health care utilization and delayed care.
OBJECTIVES:We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson’s behavioral model of health services utilization.
RESEARCH DESIGN:Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men.
SUBJECTS:A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009.
MEASURES:Predisposing, enabling, and health system environment factors, and delayed needed health care.
RESULTS:Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination.
CONCLUSIONS:Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications.
Purpose
Transgender and gender diverse (TGD) patients face significant hurdles in accessing affirming, knowledgeable care. Lack of provider knowledge presents a substantial barrier to both primary ...and transition‐related care and may deter patients from seeking health care. Little is known about factors that affect provider knowledge or whether exposure to TGD health content during training is associated with improved knowledge among providers. Using the TGD Healthcare Knowledge Scale, this study aimed to determine whether prior education on TGD health predicts clinicians’ current knowledge regarding health care for TGD patients.
Methods
An online survey examining exposure to TGD content and knowledge of TGD health care was distributed to all primary care providers in an integrated health care system in the Midwestern United States. Multivariable linear regression was used to predict provider knowledge, controlling for demographics, transphobia and other potential confounders.
Results
The response rate was 57.3% (n = 223). The mean knowledge score was 7.41 (SD = 1.31) on a 10‐point scale. Almost half (48.4%, n = 108) had no formal education on TGD health care, yet half (49.7%, n = 111) of providers reported previously caring for at least one transgender patient. In regression analysis, provider knowledge of TGD health care was associated with transphobia (β = −0.377, 95% CI = −0.559 to −0.194, p < 0.001), but not with hours of formal education (β = −0.027, 95% CI = −0.077 to 0.023, p = 0.292) or informal education (β = −0.012, 95% CI = −0.033 to 0.009, p = 0.259).
Conclusions
Increasing hours of education related to TGD health care may not be sufficient to improve providers’ competence in care for TGD individuals. Transphobia may be a barrier to learning that needs to be addressed. Broader efforts to address transphobia in society in general, and in medical education in particular, may be required to improve the quality of medical care for TGD patients.
By studying transgender healthcare, Stroumsa et al. discover that caregivers’ prejudices (transphobia) better predict competence than their knowledge.
Abstract Transgender patients report negative experiences in health care settings, but little is known about clinicians’ willingness to see transgender patients. We surveyed 308 primary care ...clinicians in an integrated Midwest health system and 53% responded. Most respondents were willing to provide routine care to transgender patients (85.7%) and Papanicolaou (Pap) tests (78.6%) to transgender men. Willingness to provide routine care decreased with age; willingness to provide Pap tests was higher among family physicians, those who had met a transgender person, and those with lower transphobia. Medical education should address professional and personal factors related to caring for the transgender population to increase access.
Limited evidence suggests that transgender individuals smoke at significantly higher rates than the general population. We aimed to determine whether structural or everyday discrimination experiences ...predict smoking behavior among transgender individuals when sociodemographic, health, and gender-specific factors were controlled.
Data from the National Transgender Discrimination Survey (N = 4781), a cross-sectional online and paper survey distributed to organizations serving the transgender community, were analyzed in order to determine the association between current smoking and discrimination experiences and other potential predictors. Logistic regression models were used to establish factors that predict smoking.
Participants reported experiencing both structural (80.4%) and everyday (65.9%) discrimination. Multivariate analyses showed that participants who reported attending some college, graduating college, or having a graduate degree were less likely to smoke compared to those with a high school degree or less. Uninsured participants were more likely to report smoking compared to those with private insurance. Those who used alcohol or drugs for coping were also more likely to smoke. Participants whose IDs and records listed their preferred gender were less likely to smoke (OR = 0.84); those who had experienced structural discrimination were more like to report smoking (OR = 1.65).
Further research is needed in order to explore the relationship between smoking and legal transition among transgender individuals. Strategies to prevent smoking and encourage cessation among this vulnerable population are also needed. In addition, comprehensive collection of gender identity data in the context of national surveys, tobacco-related research, and clinical settings is sorely needed.
This study establishes a link between experiences of structural discrimination among transgender individuals and smoking status.
Most transgender individuals either use or are interested in using gender-affirming hormone therapy (HT). Making gender-affirming HT available in primary care is critical for quality care to this ...vulnerable population. The barriers that transgender patients experience to accessing this treatment may be exacerbated if primary care providers (PCPs) will not provide it. Little is known about PCPs' willingness to administer HT to transgender patients.
To examine whether PCPs are willing to continue prescribing HT for transgender patients and the factors that predict such willingness.
An online survey of internal and family medicine physicians and residents practising in a large integrated Midwest health system (n = 308); 158 responded to the relevant questions (51.3%).
Approximately 50% of respondents were willing to continue HT for transgender patients. Most participants had previously met a transgender person (77%), and approximately half of them had cared for a transgender patient in the past 5 years. Multivariate logistic regression results indicate that attending physicians had lower odds of willingness to continue HT compared with medical residents, and those who reported perceived capability of providing routine care to transgender patients had higher odds of willingness.
Only about half of PCPs surveyed were willing to continue HT for transgender patients. Our study indicates that both personal and clinical factors play a role. Future research should address ways to increase PCPs' willingness and comfort related to continuing HT for transgender patients.
Purpose:
Transgender individuals face barriers to accessing gender-affirming hormone therapy, yet little is known about gynecological providers' willingness to provide such care.
Methods:
We surveyed ...gynecological providers in one healthcare system to determine their willingness to prescribe hormone therapy (HT) for transgender patients and factors associated with willingness to both initiate and refill HT.
Results:
Among respondents (
N
= 60), 60.3% and 27.6% were willing to refill and initiate HT for transgender patients, respectively. Willingness to refill HT was associated with having met a transgender person and lower transphobia. Unwillingness was associated with lack of transgender health training, lack of staff knowledge about transgender health, and unfamiliarity with transition guidelines. Willingness to initiate HT was associated with younger age and resident status. Unwillingness was associated with unfamiliarity with transition guidelines.
Conclusion:
While gynecological providers are qualified to prescribe HT for transgender patients, willingness to do so may be influenced by both personal and educational/training factors. Encouraging and training gynecological providers to provide gender-affirming HT will help to increase access for transgender individuals.
Competent social work practice with sexual minorities requires educators to identify factors that can be addressed in the graduate social work curriculum to foster affirming attitudes among students. ...This study explored the attitudes incoming master of social work (MSW) students hold toward sexual minorities, utilizing a scale that addresses contemporary subtle biases toward lesbian, gay, and bisexual (LGB) people, rather than overt, fear- and morality-based objections measured in previous studies. We explored the role of race/ethnicity, age, sex, sexual orientation, religiosity, political ideology, perceived biological causation of sexual orientation, and LGB social contacts on students' attitudes toward sexual minorities. Multivariable linear regression results suggest that being African American/Black (versus White), older, and heterosexual (versus sexual minority), and greater religiosity (importance of religion and frequency of service attendance) and conservative political ideology, predicted less affirming attitudes, while greater endorsement for genetic causation of sexual orientation and exposure to LGB friends and immediate family members each predicted more affirming attitudes among our sample.
This study examined the relationship of community-level stressors to behavioral and emotional problems among African-American and white children with special health care needs.
The authors ...interviewed 257 low-income caregivers of children with special health care needs in an urban Midwestern city who brought their child for a primary health care visit to a community health center between September 2001 and May 2002. Sociodemographic characteristics as well as information about the children's behavioral and emotional problems, the health status of the children, perceptions of urban community stress, access to health care, and satisfaction with health care were collected to determine racial differences in the impact of urban stress on behavioral and emotional problems.
Urban community stressors, race, and child's health status were significantly associated with behavioral and emotional problems among children with special health care needs. The association between urban stress and total behavioral problems did not differ by race.
When caring for children with special health care needs, especially those with emotional or behavioral problems, primary care providers may be better able to identify important aggravating factors if they also assess urban stress. Systems of care are needed that can assist in addressing urban community-level stressors.
Intimate partner violence (IPV) causes approximately 2 million injuries and 1300 deaths each year. Despite the high frequency of IPV among women seeking healthcare, only a small proportion report ...being asked by healthcare professionals about abuse. This study examined perceived barriers to IPV screening among obstetricians/gynecologists, family physicians, and internists, so that protocols for IPV training can be tailored to those particular areas of difficulty.
A cross-sectional survey of 143 obstetricians and gynecologists, family practice physicians, and internists in a medium-sized upstate New York city was conducted. Factor analysis was performed. Two IPV barrier domains emerged and were examined using a multivariate analysis to determine associations between the domains and physician characteristics.
For general knowledge, there were greater perceived barriers if the respondent was male but fewer perceived barriers if the respondent was an obstetrician/gynecologist and fewer perceived barriers if the respondent had 5-10 years in practice. For practice policy, there were greater perceived barriers if the physician was in a private practice setting and fewer perceived barriers if the physician was an obstetrician/gynecologist.
These findings provide direction for training in IPV recognition. They support a need for continued training throughout the physician's career. More importantly, the findings support a need for better practice systems to encourage routine screening for IPV by healthcare providers.
This study attempted to gain a better understanding of the effect of ecological and individual risk factors on infant health for black and white women in a large metropolitan city. The study examined ...the association among neighborhood economic indicators, neighborhood quality, access to prenatal care, and individual perinatal risk factors and subsequent birthweight among 78,415 black and 60,346 white residents of New York City in 1991 and 1992. Multivariate analyses indicated the continuing importance of factors such as smoking and being uninsured as individual-level risk factors for low-birthweight babies, particularly among black women. The implications of these findings emphasize the need for socially and ecologically focused policies that can reduce individual-level risks for low birthweight in the future.
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